Health Risks among People with Severe Mental Illness in Psychiatric Outpatient Settings

Monitoring Persons' Rights to Equal Care: Registered Nurses' Experiences of Caring for People with Mental Ill-Health and Somatic Comorbidity in Psychiatric Outpatient Care

Persons with severe mental ill-health die early from preventable physical ill-health. Registered nurses in psychiatric outpatient care play a key role in improving persons' physical health, and it is important to examine how they view their responsibility, their experiences of care, and the obstacles they meet in providing person-centred care. The purpose of this study was to explore registered nurses' experiences of caring for persons with mental ill-health and somatic comorbidity in psychiatric outpatient care, using qualitative content analysis to analyze data from semi-structured interviews. The results show that these nurses monitored the person's right to equal care, embraced the whole of the persons suffering, and dealt with unclear boundaries in care. This highlights the unique role that registered nurses play in psychiatric outpatient care via their ability to interpret symptoms and find ways to adapt care based on persons' needs. Registered nurses consider physical health in all care and provide a link between psychiatric and somatic care. Together with mental health nurses at primary health care centers, they are key in reducing persons' suffering. There is a need for structural and functional changes in line with person-centred care including collaboration both within and outside healthcare organizations.

Occupation and life satisfaction among individuals with mental illness: the mediation role of self-reported psychophysiological health

Background

Unemployment can diminish physical, psychological and social health. In this context, research shows that people with mental illness have even more difficulties finding occupation. Thus, some countries, such as Sweden, strive after creating job opportunities for this specific group. We investigated the effect of having an occupation on life satisfaction among individuals with mental illness and whether self-reported physical and psychological health mediated the relationship between being (un)employed and life satisfaction.

Method

Two-hundred eighty-seven individuals (148 males, 134 females, and 5 missing information) with mental illness, who received support and services from Swedish Municipalities in Blekinge, self-reported occupation, life satisfaction, and physical and psychological health.

Results

Participants who reported having an occupation reported also significantly higher levels of life satisfaction, physical health, and psychological health compared to those without occupation. Nevertheless, these differences were rather small (Eta² < 0.06). Moreover, the indirect effect of having an occupation on life satisfaction through physical and psychological health was significant. Finally, the total indirect effect of physical and psychological health (i.e., psychophysiological health) accounted for 53% of the total effect of having an occupation on life satisfaction.

Conclusion

For individuals with mental illness there seems to be an almost equal importance of indirect and direct effects of having an occupation on their levels of life satisfaction. More specifically, while there are differences in life satisfaction within this population in relation to having an occupation, having an occupation leads to the sense of good psychophysiological health, which in turn helps individuals with mental illness to feel satisfied with their lives.

"Waiting in the Wings"-Next-of-Kin's Experiences of Lifestyle Interventions for People with Schizophrenia

People with schizophrenia have an increased risk of experiencing physical ill health and thus risk premature death. It is important to gain knowledge about the next-of-kin's experiences of lifestyle interventions in order to increase the understanding of the development of health promotion. This study aimed to describe the experiences of next-of-kin of lifestyle interventions for people with schizophrenia. Ten next-of-kin to people diagnosed with schizophrenia were interviewed and content analysis was used to analyze the data. Three categories emerged in the analysis: Low prioritization of physical health, Patients' needs for motivational support and Next-of-kin's' limited and distant participation. Mental health nurses need a holistic view of human beings and to include the patients' physical health and the role of the family in their responsibilities. Further studies are needed that focus on the views of the next-of-kin and the staff from the mental health services about the care and support needs for promoting physical health in this patient group.

Health Effects of an Individualized Lifestyle Intervention for People with Psychotic Disorders in Psychiatric Outpatient Services: A Two Year Follow-up

People with psychotic disorders experience to a great extent avoidable physical illnesses and early mortality. The aim of the study was to investigate the potential effects for this group of participating in a lifestyle intervention. A multi-component nurse-led lifestyle intervention using quasi-experimental design was performed. Changes in biomedical and clinical measurements, self-reported health, symptoms of illness and health behavior were investigated. Multilevel modeling was used to statistically test differences in changes over time. Statistically significant changes were found in physical activity, HbA1c and waist circumference. A lifestyle intervention for people with severe mental illness can be beneficial for increasing physical activity.

Causes of premature mortality in schizophrenia: a review of literature published in 2018

PURPOSE OF REVIEW

The current review examines the recent literature on the causes of premature mortality in schizophrenia.

RECENT FINDINGS

People with schizophrenia have higher premature mortality rates compared with the general population. Suicides and accidents account for a nontrivial part of the excess mortality, but the largest part is attributable to natural causes of death. Five major causes have been identified: first, adverse effects of medication; second, suboptimal lifestyle; third, somatic comorbidity; fourth, suboptimal treatment of somatic disorders; and fifth, accelerated ageing/genetic explanations. The positive aspect is that people with schizophrenia have increasing life expectancy, at least in high-income countries, and this development seems to largely follow the increase in the general population. Especially mortality rates from unnatural causes appear to have a positive impact. Nevertheless, despite more than 100 years of research and progress, the excess mortality in persons with schizophrenia remains unacceptably high, with no prospects of reaching the level in the general population.

SUMMARY

The excess mortality in schizophrenia has received much focus. Future studies should explore the reasons for the high rates of natural causes of death, while aiming to disentangle the complex interplay between medication, lifestyle, comorbidity, treatment of somatic disorders, and genetic effects.

Health-related lifestyle and perceived health among people with severe mental illness: Gender differences and degree of sense of coherence

People with severe mental illness (SMI) experience an increased risk of physical ill health and premature death, which appears to be partly related to unhealthy lifestyle habits. The aim of this study was to describe the distribution of health-related lifestyle habits and perceived health among people with severe mental illness. A further aim was to explore if there were any gender differences or differences based on degree of sense of coherence. The study adopted a cross-sectional design based on data from 65 people with SMI. The results show that degree of Sense of Coherence (SOC) does have relevance for perceived health and for dimensions of Quality of Life (QOL). Furthermore, among the participants with strong SOC, there were less daily smokers and they seemed to have less sedentary leisure time than those with low SOC. Men reported more anxiety/depression than women and women ate fruit more often than men, otherwise there were no gender differences. In comparison with the general population, people with SMI show a higher Body Mass Index are more sedentary, more often daily smokers, have lower SOC and perceive a lower QOL. This emphasizes the importance of health-promotion support that focuses on lifestyle changes, and support for strengthening SOC and QOL for people with SMI.